Chronic Intermittent Hypoxia Induces Atherosclerosis

Savransky, Vladimir; Nanayakkara, Ashika; Li, Jianguo; Bevans, Shannon; Smith, Philip L.; Rodríguez, Annabelle; Polotsky, Vsevolod Y.

doi:10.1164/rccm.200612-1771oc

Cited by 348 publications

(272 citation statements)

References 55 publications

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“…After the first acute myocardial infarction, 65.7% of patients had an apnea-hypopnea index ≥ 15/h 35 . In other studies, the prevalence of OSA in patients with artery heart disease ranged from 43 to 66.4% 36,37,38,39 . The prevalence of a high risk of coronary artery disease associated with OSA in our survey was within these estimates.…”

Section: Discussionmentioning

confidence: 75%

Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease

et al. 2012

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Obstructive sleep apnea (OSA), a risk factor for coronary artery disease, remains under diagnosed. We investigated if OSA identified by the Berlin Questionnaire (BQ) is associated with the risk of coronary artery disease. Cases were patients referred for elective coronariography. The cases were classified with significant coronary lesions (stenosis > 50% in an epicardial coronary) or without significant coronary lesions. Controls were selected from a population-based sample. Positive BQ results were identified in 135 (41.2%) of 328 cases, in contrast with 151 (34.4%) of 439 control subjects (p = 0.03). In a multinomial logistic analysis, the risk for OSA identified by the BQ was independently associated with coronary artery disease in cases with lesions of at least 50% (OR = 1.53; 95%CI: 1.02-2.30; p = 0.04). The risk from OSA identified by the BQ was higher in younger subjects (40-59 years) (OR = 1.76; 95%CI: 1.05-2.97; p = 0.03) and in women (OR = 3.56; 95%CI: 1.64-7.72; p = 0.001). In conclusion, OSA identified by the BQ greatly increases the risks of coronary artery disease in patients having significant coronary artery lesions indicated by anangiogram, particularly in younger individuals and in women.

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Section: Discussionmentioning

confidence: 75%

Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease

et al. 2012

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“…7 Chronic intermittent hypoxia causes dyslipidaemia and initiates the development of atherosclerosis, both of which contribute to arterial stiffness. 24 Decreasing nocturnal apnea-hypopnea by CPAP treatment may protect OSA patients from the progression of arterial stiffness, as well as decreasing blood pressure in these patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of long-term treatment for obstructive sleep apnea on pulse wave velocity

Saito

Sugiyama

et al. 2010

Hypertens Res

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Continuous positive airway pressure (CPAP) treatment improves endothelial function and sympathetic activity in patients with obstructive sleep apnea (OSA). However, the long-term effects of CPAP on pulse wave velocity (PWV), which reflects arterial stiffness that is associated with cardiovascular events, have not been evaluated in OSA patients with or without hypertension (HT). In this study, 212 male OSA patients who had been receiving CPAP treatment for 2 years and were divided into two groups, those with HT (n¼114) and those without (n¼98), were studied. In both HT and normotensive (NT) patients, PWV decreased significantly over the first 6 months of treatment (P¼0.005 and 0.010, respectively), before increasing gradually from 6 to 24 months. Body mass index (BMI), body weight, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels decreased significantly in the HT group over the 2 years of CPAP treatment (Po0.001 for all). In contrast, only HR decreased significantly in the NT group over the 2 years of treatment (Po0.001). Multivariate regression analysis revealed that age (P¼0.008), decreases in DBP (Po0.001) and HR (Po0.001) and higher initial levels of serum high-density lipoprotein-cholesterol (P¼0.040) were independent factors related to changes in PWV over the 2 years of CPAP treatment in all patients. In conclusion, we found a significant decrease in PWV in both NT and HT patients after 6 months of CPAP treatment. In HT patients, long-term CPAP treatment significantly decreases blood pressure, which may contribute to explain the PWV improvement.

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“…Oxidative stress would result in the activation of inflammatory pathways [38,39], such as those mediated by nuclear factor-kB, tumour necrosis factor-a, interleukin (IL)-6 and IL-8, all parameters that are found to be elevated in OSAS patients and modified by therapy [21,25]. Studies in humans [40] have confirmed the key role of chronic intermittent hypoxia, more than that of the AHI, in the development of atherosclerosis in SDB and on partial reversal by efficacious therapy [41]. Therefore, atherosclerotic lesions and inflammatory processes, induced by intermittent hypoxia, contribute to long-term increased cardiovascular morbidity and mortality described in patients with SDB [42,43].…”

Section: Discussionmentioning

confidence: 99%

Association between C-reactive protein and unrecognised sleep-disordered breathing in the elderly

Roche¹,

Jm²,

Pichot³

et al. 2009

Eur Respir J

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Elevated levels of C-reactive protein (CRP) have been reported in patients with sleep-disordered breathing (SDB) and may represent an inflammatory marker of cardiovascular risk. However, the association of CRP with SBD in presumed healthy elderly subjects is unknown.In total, 851 (58.5% females) 68-yr-old subjects, who were free of any known cardiac or sleep disorders, were prospectively examined. Subjects underwent unattended polygraphy, and the apnoea/hypopnoea index (AHI) and oxyhaemoglobin desaturation index (ODI) were assessed. Elevated levels of CRP were found on the morning after the sleep study in patients with more severe SDB. A significant correlation was found between CRP levels, time spent at night with arterial oxygen saturation ,90% and ODI. No association was found between CRP levels and AHI. After adjustments for body mass index, smoking status, hypertension, diabetes and dyslipidaemia, a significant association remained between CRP levels and ODI .10 events?h -1 .CRP levels were frequently increased in a large sample of elderly subjects free of major cardiovascular disease. CRP levels were not correlated with the AHI and the indices of sleep fragmentation; the ODI .10 events?h -1 was the strongest predictor of raised CRP level.The present results suggest that, in the elderly, intermittent hypoxaemia may underlie inflammatory processes leading to cardiovascular morbidity. KEYWORDS: C-reactive protein, elderly, hypoxaemia, inflammation, sleep apnoea O bstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder affecting 2-4% of the general population and is considered an independent risk factor for cardiovascular diseases [1-3], particularly hypertension, coronary artery disease, heart failure and stroke [4,5]. Furthermore, newly diagnosed OSAS patients, free of classical cardiovascular risk factors, such as hypertension, diabetes and smoking, may have early signs of atherosclerosis [6]. Although the pathophysiology of cardiovascular risk is mutifactorial, sympathetic hypertonia [7], endothelial dysfunction [8, 9] and insulin resistance [10] have been postulated as factors initiating and sustaining inflammatory microvascular alterations and therefore atherosclerosis [11,12]. In middle-aged OSAS patients, C-reactive protein (CRP), a marker of inflammation in atherosclerotic lesions [13], is elevated in severe cases [14] and decreases after treatment with nasal continuous positive airway pressure [15]. Despite the putative role of CRP in cardiovascular risk in OSAS, studies conducted to date have yielded contradictory results, with some showing an independent association with disease severity in adults [16][17][18][19] and children [20,21], and others showing no relationship [22,23]. Moreover, the association between obesity and CRP [24] raised the question as to whether elevated CRP reflects the effects of obesity or whether it is specific to OSAS itself.In the elderly, the prevalence of sleep-disordered breathing (SDB) is estimated to be higher than in middle-aged subjects. AN...

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Chronic Intermittent Hypoxia Induces Atherosclerosis

Cited by 348 publications

References 55 publications

Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease

Obstructive sleep apnea, detected by the Berlin Questionnaire: an associated risk factor for coronary artery disease

Effects of long-term treatment for obstructive sleep apnea on pulse wave velocity

Association between C-reactive protein and unrecognised sleep-disordered breathing in the elderly

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